Healthcare Provider Details

I. General information

NPI: 1497486146
Provider Name (Legal Business Name): SIERRA ROSE POELSTRA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SIERRA NICOLE ROSE DDS

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KIECKER DENTAL CLINIC 2803 MEDICAL CAMPUS DRIVE
GOLDSBORO NC
27531-2301
US

IV. Provider business mailing address

3067 HUDSON TER
NAPLES FL
34119-3383
US

V. Phone/Fax

Practice location:
  • Phone: 919-722-1733
  • Fax:
Mailing address:
  • Phone: 239-821-8276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00205208
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: